The last few weeks I’ve had a couple of weird episodes of HR jumping unexpectedly by 20-30bpm with no change in pace.
It typically happens following a PVC (I’ve had these for years mostly due to stress) and most of the time returns to normal after a few minutes.
Since I got an HRM that can capture ECG I did a few and there are clear bouts of supraventriular tachycardia with regular heart beat not irregular. Sent that to a friend of mine who is an interventional cardio and who confirmed runs of SVTs.
So now we are going to check blood (had a recent blood test so don’t expect anything to show) and do an echo to rule out structural issues.
I’ll add this to the bouts of vagally mediated atrial fibrillation that I got over the years (6 total maybe since 2002 and for which I found the trigger (very cold drinks drunk too fast) so been able to avoid them.
The SVTs are more problematic and likely of the atrioventricular node reentrant tachy type. So next step is to consider ablation.
Has anyone gone this undergone ablation for SVT? How did it go? It seems that the mapping is a lot more stable these days than a few years ago so success, which is largely due to how well you identify the defective circuit is more likely.
I’ve sent dozens of patients for SVT ablations over the years-almost always to good outcomes and low procedural risk, but there have been a few instances of bigger trouble…
My son has PSVT/avnrt-at a rate of ~220 when it acts up, which is rarely at this point, but fortunately he’s young *(and knows and avoids triggers now) and can tolerate that rate. As you know, slower rates are somewhat better tolerated.
Success rates are quite good. ~95% success. Definitely need an echo to look for structural heart disease.
Here’s a study from Germany-
https://www.ncbi.nlm.nih.gov/...articles/PMC9054935/
Main findings of the study
The main findings of our analysis of 12,536 patients with (37.2%) and without SHD (62.8%) undergoing SVT ablation within the multi-center German ablation registry can be summarized as follows: (1) Patients with SHD differ with respect to baseline characteristics (older, more co-morbidities, higher amount of previous antiarrhythmic drug failure) and ablation procedure performed (more patients undergoing ablation for atrial flutter and ablation of the atrioventricular node for AF treatment). (2) Overall acute success rates were slightly lower in patients with versus without SHD, while complication rates were similar. (3.) During one-year follow-up, mortality and rate of MACCE were higher in patients with SHD.
Overall acute success rates were high (95.8% vs. 96.6%, p = 0.027) in patients with and without SHD.
Death, myocardial infarction or stroke (MACCE) occurred in 10 patients (0.2%) with and 6 patients (0.1%) without SHD (p = 0.066). Other major complications prior to discharge were rare (57/12523, p = 0.4%) without difference between patient groups (0.5% vs. 0.4%, p = 0.34)
There hasn’t been any updates to the Rx guidelines for psvt
Top Things to Know: Guideline for the Management of Adult Patients with Supraventricular Tachycardia
Published: September 23, 2015
Data are not well-defined for the epidemiology of SVT, but best estimates indicate the incidence is approximately 2.25 per 1000 personsThe 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia replaces the 2003 ACC/AHA guidelines for the management of patients with supraventricular arrhythmias. It utilizes new knowledge from clinical trials, treatments and drugs, and updates or replaces recommendations.Paroxysmal supraventricular tachycardia (PSVT) is a clinical syndrome characterized by the presence of a regular and rapid tachycardia of abrupt onset and termination.Women are 2 times more likely to have PSVT than men, and people >65 have a 5 times higher risk than younger people for PSVT. There are approximately 89,000 new cases per year and 570,000 persons with PSVT.Atrial fibrillation is not included in this guideline, because supraventricular tachycardia generally does not include AF.SVT describes tachycardias with atrial and/or ventricular rates > 100 bpm at rest. Examples include the following:
Inappropriate sinus tachycardia,Atrial tachycardia (including focal and multifocal atrial tachycardia),Macro re-entrant atrial tachycardia (including typical atrial flutter),Junctional tachycardia,Atrioventricular re-entrant tachycardia (AVNRT), andDifferent accessory pathway-mediated re-entrant tachycardias.SVT symptoms, which often start in adulthood, may include fatigue, syncope, light-headiness, palpitations, and chest pain. Quality of life may be affected, as well, based on the frequency, duration, and timing of the SVT. In one study, 57% of patients with SVT experienced an episode while driving, and 24% of them considered it to be an obstacle to driving.The cause of SVT may be discovered from a 12-lead ECG done during the tachycardia episode. Often SVT is diagnosed in the emergency department.Treatment options may include drug therapy, ablation or observation. Factors such as frequency and duration of the SVT as well as the symptoms and potential complications play a role in the treatment decision. The guidelines include several treatment algorithms that address acute, ongoing management.The treatment options for SVT are specific to the type of arrhythmia and treatment can be nuanced. Shared decision making is stressed in this document with attention to the patient’s preferences and treatment goals and their individual situations.
Good luck to you!